Renal Dose Adjustment (Based on CrCl)
- >60 mL/min: No dose adjustments; monitor serum creatinine and potassium; caution advised
- 30-60 mL/min: Dose adjustments recommended, however however exact dose adjustments not defined
- <30 mL/min: Contraindicated
Hepatic Dose Adjustment
- Mild to moderate impairment: No dose adjustments; caution advised
- Severe impairment: Contraindicated
- Use of ACE inhibitors during second and third trimesters of pregnancy can cause fetal morbidity/mortality, hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure. When pregnancy is detected, discontinue therapy as soon as possible. If continuing ACE inhibitor therapy is essential, patients planning pregnancy should be changed to alternative anti-hypertensive treatments with better safety profiles
- If no alternative to ACE inhibitors is there, then mothers should be apprised of the potential hazards to their fetus and serial ultrasound examinations should be performed to check of renal function and skull
- Neutropenia, agranulocytosis, thrombocytopenia and anemia have been reported in patients receiving ACE inhibitors, including imidapril; risk appears to be greater with renal dysfunction, heart failure, or immunosuppression; periodically monitor WBC counts any signs of infection (e.g. sore throat, fever)
- Angioedema involving the extremities, face, lips, tongue, glottis or larynx and also intestinal angioedema has been reported in patients treated with ACE inhibitors. If airway obstruction occurs, promptly administer emergency therapy such as epinephrine. The incidence of angioedema is higher in black patients receiving ACE inhibitor
- Life-threatening anaphylactoid reactions have occurred in patients undergoing desensitizing therapy with hymenoptera venom while receiving ACE inhibitors. Patients dialyzed with high-flux membranes and concomitantly treated with an ACE inhibitor and patients undergoing low-density lipoprotein apheresis with dextran sulfate absorption are prone to anaphylactoid reactions
- Therapy with thiazide diuretics in patients with impaired liver function may cause hepatic encephalopathy. Discontinue the therapy immediately as soon as symptoms occur
- Perindopril monotherapy causes hyperkalemia and conversely treatment with thiazide diuretics has been associated with hypokalemia. The opposite effects of perindopril and indapamide on serum potassium balance each other in some patients and one or the other effect may be dominant in some, monitor serum electrolytes to detect possible electrolyte imbalance periodically
- Photosensitivity reactions may occur during therapy with thiazides diuretics. If photosensitivity reaction occurs during treatment, discontinue the therapy
- Symptomatic hypotension has been reported with ACE inhibitors, more likely in patients who have been volume or salt-depleted. Excessive hypotension causes oliguria or azotemia, acute renal failure and could result in MI or a cerebrovascular accident in patients with ischemic heart disease or cerebrovascular disease. If excessive hypotension occurs place the patient in supine position and treat with IV infusion of physiological saline. Careful observation for clinical signs of water and electrolyte depletion is recommended; regularly monitor serum potassium, uric acid and plasma electrolyte levels
- Persistent nonproductive cough, due to inhibition of the degradation of endogenous bradykinin has been reported with ACE inhibitors
- Symptomatic hypotension may occur after the first dose of perindopril, especially in volume depleted patients such as those on diuretic tx, dialysis, salt restriction, IHD, renal impairment, and cerebrovascular disease. Monitor for up to 6-8 hrs after administration of first dose. Therapy may require correction in salt and body fluids deficiencies and discontinuation of an existing diuretic therapy for two to three days before ACE inhibition
- Patients with bilateral renal artery stenosis or those w/ stenosis of the artery to a single functioning kidney are at an increased risk of hypotension and development of renal insufficiency when treated with ACE inhibitors
- Use cautiously in patients with diabetes mellitus; closely monitor blood glucose levels
- Rarely, ACE inhibitors can cause cholestatic jaundice progressing to fulminant hepatic necrosis and sometimes death, discontinue therapy if marked elevations of hepatic enzymes occur
- Closely observe the infants with history of in utero exposure to ACE inhibitors, for hypotension, oliguria and hyperkalemia
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Risk of hypotension
- Collagen vascular disease
- Mitral valve stenosis
- Aortic valve stenosis
- Immunosuppressant therapy
- Treatment with allopurinol or procainamide
- Allergic patients treated with desensitization
- Obstruction in the outflow tract of the left ventricle
- Fluid and electrolyte imbalance
- Progressive electrolyte abnormalities
- Diabetes mellitus
- Elderly patients
Pregnancy Category:NR; contraindicated. ACE inhibitors can cause injury and even death of the developing fetus. When pregnancy is detected, it should be discontinued as soon as possible. ACE inhibitor therapy in 2nd/3rd trimester is associated with fetal morbidity/mortality.
Breastfeeding: Safety and efficacy during lactation have not been established; contraindicated
US Trade Name(s)
US Availability
Canadian Trade Name(s)
- Conversyl Plus
- Conversyl Plus HD
- Conversyl Plus LD
Canadian Availability
Conversyl Plus (indapamide/perindopril)
Conversyl Plus HD (indapamide/perindopril)
Conversyl Plus LD (indapamide/perindopril)
UK Trade Name(s)
UK Availability
Conversyl Arginine Plus (indapamide/perindopril)
Australian Trade Name(s)
Australian Availability
indapamide/perindopril (generic)